College of Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA.
College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Eur Spine J. 2024 Nov;33(11):4346-4352. doi: 10.1007/s00586-024-08447-8. Epub 2024 Sep 2.
The identification of gene mutations in the modern medical workup of metastatic spine tumors has become more common but has not been highly utilized in surgical planning. Potential utility of these genetic markers as surrogates for cancer behavior in current prognosis scoring systems and overall survival (OS) remains underexplored in existing literature. This study seeks to investigate the association of frequently identified tumor markers, EGFR, ALK, and PD-L1, in metastatic non-small cell lung cancer (NSCLC) to the spine with Tokuhashi prognosis scoring and OS.
Patients with NSCLC metastasis to spine were identified through chart review. EGFR, ALK, and PD-L1 wild type vs. mutant type were identified from targeted chemotherapy genetic testing. Multiple linear regression was performed to assess gene profile contributions to Tokuhashi score. Cox Proportional Hazards models were generated for each tumor marker to assess the relationship between each marker and OS.
A total of 119 patients with NSCLC spine metastasis were identified. We employed a multiple linear regression analysis to investigate the influence of EGFR, ALK, and PD-L1 genotypes on the Tokuhashi score, revealing statistically significant relationships overall (p = 0.002). Individual genotype contributions include EGFR as a non-significant contributor (p = 0.269) and ALK and PD-L1 as significant contributors (p = 0.037 and p = 0.001 respectively). Overall survival was not significantly associated with tumor marker profiles through Kaplan-Meier analysis (p = 0.46) or by multivariable analysis (p = 0.108).
ALK and PD-L1 were significantly associated with Tokuhashi score while EGFR was not. Tumor markers alone were not predictive of OS. These findings indicate that genetic markers found in NSCLC metastases to the spine may demonstrate prognostic value. Therefore, employing standard tumor markers could enhance the identification of appropriate surgical candidates, although they demonstrate limited effectiveness in predicting overall survival.
在转移性脊柱肿瘤的现代医学评估中，基因突变更为常见，但在手术计划中尚未得到广泛应用。这些遗传标志物作为当前预后评分系统和总生存（OS）中癌症行为的替代指标的潜在效用在现有文献中仍未得到充分探索。本研究旨在调查在转移性非小细胞肺癌（NSCLC）脊柱转移患者中经常发现的肿瘤标志物 EGFR、ALK 和 PD-L1 与 Tokuhashi 预后评分和 OS 的关系。
通过病历回顾确定 NSCLC 脊柱转移患者。从靶向化疗基因检测中确定 EGFR、ALK 和 PD-L1 野生型与突变型。采用多元线性回归评估基因谱对 Tokuhashi 评分的贡献。为每个肿瘤标志物生成 Cox 比例风险模型，以评估每个标志物与 OS 的关系。
共确定了 119 例 NSCLC 脊柱转移患者。我们进行了多元线性回归分析，以研究 EGFR、ALK 和 PD-L1 基因型对 Tokuhashi 评分的影响，结果总体上具有统计学意义（p=0.002）。个体基因型的贡献包括 EGFR 无显著贡献（p=0.269），ALK 和 PD-L1 为显著贡献（p=0.037 和 p=0.001）。通过 Kaplan-Meier 分析（p=0.46）或多变量分析（p=0.108），总体生存与肿瘤标志物谱均无显著相关性。
ALK 和 PD-L1 与 Tokuhashi 评分显著相关，而 EGFR 则不然。肿瘤标志物单独不能预测 OS。这些发现表明，在 NSCLC 脊柱转移中发现的遗传标志物可能具有预后价值。因此，尽管在预测总体生存方面效果有限，但采用标准肿瘤标志物可能有助于识别合适的手术候选者。
